| Questionnaire |
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| 2.
How soon after you wake up do you smoke your first cigarette? |
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| 3.
Which cigarette would you hate most to give up? |
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| 4. On a scale of 0 to 10, how confident are you that you
would be able to stop smoking permanently if you decided to do so? |
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| 5.
How many years have you been smoking?
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| 6.
During the past 7 days, how many cigarettes did you smoke on a typical
day?
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| 7. How many times have you made a serious attempts to quit
smoking? |
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| 8. If you quit smoking in the past, what was the longest
time before you started again? |
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| 9. How many people in your household, excluding yourself,
currently smoke cigarettes? |
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| 10. Of all the people you see in an average week - that is
at work, at home, and while socializing - how many of them smoke? |
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| 11.
Do you smoke more frequently during the first hours after waking than during
the rest of the day? |
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| 12.
Do you smoke if you are so ill that you are in bed most of the day? |
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| 13.
Do you find it difficult to refrain smoking in places where it is not allowed
(such as in church, at the library, at the movies, etc.)? |
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| 14. What is your gender?
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| 15.
Wake up Time (to the nearest hour)
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| Your results will be emailed to you shortly. |
| Your Email Address
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| First Name (Screen Name)
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